International Journal of Research in Medical Sciences
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Epidemioclinical aspects of breast cancer in women under 35 years at the oncology and palliative care department of Soavinandriana Hospital
Get PDFBackground: Breast cancer is rare among women under 35 years, but its incidence is increasing, particularly in low-resource settings. Young patients often present with aggressive disease and delayed diagnosis. This study aimed to describe the epidemioclinical features of breast cancer in this population.
Methods: A retrospective descriptive study was conducted from January 2014 to September 2024 at the oncology and palliative care department of Soavinandriana Hospital, Madagascar. 38 women under 35 years old with histologically confirmed breast cancer were included.
Results: Among 2,087 breast cancer cases, 38 (1.82%) involved women under 35. The mean age was 30.7 years. Most patients were pauciparous (50%), had breastfed (73.7%), were non-smokers (81.6%), and had no family history of breast or ovarian cancer (76.3%). The upper outer quadrant was the most common tumor site (34.2%). Invasive carcinoma of no special type was predominant (78.9%). Grade II and III tumors accounted for 65.8%. More than 50% of patients were diagnosed at an advanced stage (IIB or higher). Immunohistochemical and staging data were frequently incomplete due to limited diagnostic resources.
Conclusions: Breast cancer in young Malagasy women is uncommon but presents aggressively and at advanced stages, underscoring the need for early detection strategies. Improved diagnostic access and tailored screening programs are essential
Evaluation of malnutrition in chronic kidney disease patients in a tertiary health care center at Uttarakhand: a single center, cross-sectional and observational study
Get PDFBackground: Malnutrition in CKD patients contributes to an increased risk of mortality and morbidity. This study aims to explore the prevalence of malnutrition among CKD dialysis dependent and not on dialysis patients at a tertiary health care center at Uttarakhand and examining the correlations between SGA score, biochemical markers, and anthropometric measures.
Methods: A cross-sectional and observational study was performed at Nephrology department, All India institute of medical sciences, Rishikesh from March, 2023 to July, 2024. It included 150 patients. Nutritional status was assessed with subjective global assessment score that included parameters like weight, dietary intake, gastrointestinal symptoms, functional capacity, subcutaneous fat, muscle wasting, oedema and ascites. Biochemical and anthropometric measures of patients were then correlated with SGA score.
Results: Prevalence of malnutrition in CKD patients in this study was 32%. GFR significantly predicted any presence of malnutrition for CKD patients not on dialysis. Blood urea, creatinine, triglycerides, total cholesterol, LDL, phosphorus were significantly associated with SGA Score (p<0.05). Weight, height, BMI, TSF and MAC decreased with increase in degree of malnutrition and it was statistically significant (p-<0.001, p-0.0031, p-<0.001, p-<0.001 and p-<0.001 respectively).
Conclusions: Malnutrition is prevalent among CKD patients. Prevalence of malnutrition increases with disease progression. Nutritional assessment is an important part of the holistic management of CKD. Biochemical and anthropometric parameters are reliable tools for monitoring and improving patient outcomes
Role of inflammation in alcoholic liver diseases and its management
Get PDFAlcoholic liver disease (ALD) weighs a heavy health burden in India with 76% increase in disability-adjusted life years (DALYs) through 1990 to 2016. This review examines the role of inflammation in its pathogenesis and management approaches for the same. The pathophysiology of ALD involves various mechanisms such as increased gut permeability, oxidative stress and activation of inflammatory cascade, where tumor necrosis factor-alpha (TNF-α) plays a central role. Due to these varied mechanisms, the clinical presentation also varies, ranging from asymptomatic fatty liver to severe cirrhosis. As such, the management strategies range from alcohol abstinence and nutritional support to pharmacological interventions. For inflammation-predominant ALD phenotypes such as alcoholic hepatitis, corticosteroids are often used as the primary therapy. Other agents, including S-adenosylmethionine (SAMe), pentoxifylline and N-acetylcysteine, show promise in targeting the inflammatory pathogenesis of ALD. SAMe is a more specific option for targeting inflammation, while N-acetylcysteine is best used where its potent anti-oxidant activity is desired. Ultimately, liver transplantation offers the terminal option for end-stage disease, with considerations for inflammation to subside before it can be done. This review highlights the complex inflammatory mechanisms underlying the ALD spectrum and discusses various multimodal approaches for incorporating various treatment strategies.
Psoriasis and metabolic dysfunction-associated steatotic liver disease: an underestimated connection: a case report
Get PDFPsoriasis is a chronic inflammatory skin disease influenced by immunological, genetic, and environmental factors, and is closely linked to metabolic comorbidities such as metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is defined by hepatic fat accumulation in the presence of cardiometabolic risk factors such as obesity, type 2 diabetes, dyslipidemia, or hypertension. Both psoriasis and MASLD share inflammatory mechanisms, particularly involving the TNF‑α/IL‑23/IL‑17 axis, which promotes systemic inflammation, insulin resistance, steatosic liver disease, and fibrosis. We present the case of a 44-year-old man with untreated type 2 diabetes, active tobacco use, and chronic alcohol consumption, who presented with progressive abdominal distension, shortness of breath, and worsening of preexisting psoriatic lesions. Laboratory findings showed altered liver function, ultrasound confirmed ascites and grade, hepatic steatosis with fibrosis. A skin biopsy confirmed the diagnosis of psoriasis vulgaris. Initial treatment included non-selective beta-blockers, emollients, and therapeutic paracentesis, followed by referral to a tertiary care center. The coexistence of psoriasis and MetALD (a mixed form of MASLD and alcohol-related liver disease) worsens liver prognosis and limits the use of hepatotoxic drugs such as methotrexate. Therefore, early liver ultrasound in psoriatic patients with metabolic risk factors is essential to support safe therapeutic decisions and prioritize biologic treatments when liver damage is present
Hearing risk in the digital age: a systematic review on recreational audio device use among youth
Get PDFProlonged use of personal listening devices (PLDs) like earphones and headphones among young people has become a global concern due to the risk of hearing damage. This systematic review, which included 15 studies, found that such use is associated with early signs of auditory damage, particularly at high frequencies. While the quality of evidence varied, with some studies having a low risk of bias and others showing moderate concerns due to issues like selection and detection bias, key risk factors were consistently identified. These included the duration of listening, the volume level, and the use of earphones in noisy environments. The findings highlight the pressing need for standardised research and public health initiatives to promote safer listening practices among individuals aged 12-30
Effects of probiotics on neurodegenerative diseases
Get PDFNeurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis, represent a growing public health challenge due to their high prevalence and the lack of curative therapies. In this context, research on the gut–brain axis has highlighted the crucial role of the intestinal microbiota in modulating neurological processes and in the pathophysiology of these disorders. Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer health benefits to the host, have shown potential neuroprotective effects. Preclinical and clinical studies have demonstrated that probiotics may modulate neuroinflammation, reduce oxidative stress, improve blood–brain barrier integrity, and regulate the production of neurotransmitters such as serotonin, GABA, and dopamine. In Parkinson’s disease, the administration of Lactobacillus and Bifidobacterium strains has been associated with improvements in gastrointestinal symptoms and reductions in systemic inflammatory markers. In Alzheimer’s disease, probiotic supplementation has been linked to benefits in cognitive parameters and decreases in inflammatory biomarkers. Likewise, in multiple sclerosis models, probiotics appear to modulate immune responses by promoting an anti-inflammatory profile. Although current findings are promising, the heterogeneity of probiotic strains, variability in study designs, and the limited number of controlled clinical trials highlight the need for further research to establish standardized protocols. Incorporating probiotic-based therapies may represent a complementary approach in the prevention and management of neurodegenerative diseases within the framework of personalized and interdisciplinary medicine
Evaluation of C-reactive protein/albumin ratio in women with polycystic ovarian syndrome and women without polycystic ovarian syndrome
Get PDFBackground: Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology. Emerging evidence suggests a role of chronic low-grade inflammation in PCOS pathophysiology. The C-reactive protein (CRP)/albumin ratio, reflecting both inflammation and nutritional status, may serve as a sensitive biomarker in PCOS.
Methods: A cross-sectional study was conducted over one year on 100 women aged 20–40 years attending the Obstetrics and Gynaecology department of Navodaya Medical College, Raichur. Group A included 50 women without PCOS, and group B included 50 women with PCOS (diagnosed by Rotterdam criteria). Serum CRP and albumin were measured, and the CRP/albumin ratio was calculated. Data were analysed using independent t-test, Chi-square test, and ROC curve analysis. A p-value <0.05 was considered statistically significant.
Results: Women with PCOS had significantly higher BMI and waist circumference (p<0.001). CRP levels were higher (4.8±1.4 mg/l versus 1.9±0.8 mg/l) and albumin levels lower (3.2±0.5 g/dl versus 4.1±0.4 g/dl) in PCOS compared to controls, resulting in a higher CRP/albumin ratio (2.8±1.2 versus 1.4±0.6, p<0.001). Elevated ratios were present even in lean PCOS cases. ROC curve analysis yielded an AUC of 0.89, with sensitivity 70% and specificity 84% at a cut-off >2.0.
Conclusions: CRP/albumin ratio is significantly elevated in PCOS, independent of obesity, and may serve as a simple, cost-effective marker of inflammation and metabolic dysfunction, aiding early diagnosis and risk stratification
Midgut malrotation presenting as duodenal obstruction in an adult: a rare entity!
Get PDFIntestinal malrotation is a congenital anomaly of the small bowel with an incidence of 1 in 500 live births, mostly presenting in infancy. Presentation in adults is rare. A 46 -year-old male presented with acute pain in abdomen, obstipation and bilious vomiting. The patient was vitally stable with insignificant clinical examination and normal hematological investigations. On abdominal CT, abnormal right sided small bowel loops with pulled up caecum in the midline, fibrotic bands extending from the DJ flexure towards the caecum, and Whirlpool sign relating to the superior mesenteric vein were seen. The patient was managed conservatively initially, and subsequently a Ladd’s procedure was performed. Post operative course was uneventful. Though rare after childhood, symptomatic midgut malrotation may present in adults. Thus, high index of suspicion in patients presenting with non-specific abdominal pain and recurrent bilious vomiting, allows early recognition and management of this rare cause of small bowel obstruction
Microbiological profile of central line-associated bloodstream infections at a tertiary care facility
Get PDFBackground: High-risk and critically ill patients admitted to the ICU often require catheter insertion for administering fluids, blood products, medications, and performing hemodynamic monitoring. Healthcare-associated infections (HAIs) are common in the ICU due to prolonged hospital stays. Central line-associated bloodstream infections (CLABSI) are significant healthcare-associated infections that necessitate surveillance to decrease their occurrence. This study aims to identify the etiological agents and AST patterns of CLABSI in the Medicine ICU.
Methods: A hospital-based surveillance study was conducted from January to December 2023 in the medicine ICU. Blood samples were collected from suspected patients, processed, organisms isolated, and their antibiotic susceptibility tested following our department’s SOPs. CLABSI was diagnosed as per the AIIMS guidelines. CLABSI rates were calculated monthly as part of an HIC surveillance. IPC measures were implemented to reduce the CLABSI rate under surveillance.
Results: Out of 628 blood samples received from the medicine ICU, 178 (28.3%) were positive by culture, and 450 were sterile. Of the 178 positive samples, 65 (10.35%) cases were HAI BSI, with 19 (3.02%) being CLABSI HAI and 46 (7.32%) non-CLABSI HAI. Among CLABSI HAI, Gram-negative bacteria (GNBs) are the most common organisms, accounting for 68.4% of isolates, while Gram-positive bacteria (GPBs) contribute 31.6%.
Conclusions: Excessive use of invasive procedures increases the risk of MICU patients becoming colonized with highly resistant bacteria. Identifying the range of bacteria causing BSI helps clinicians apply proper management strategies and antibiotic policies to improve patient outcomes
Antibiotic usage in surgical prophylaxis: a prospective observational study in the surgical wards of a tertiary care hospital
Get PDFBackground: Surgical site infections (SSIs) are a leading cause of postoperative complications, particularly in resource-limited settings. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs when administered with appropriate antibiotic selection, timing, and duration. This study aimed to evaluate the SAP practices in elective surgeries and assess adherence to national and international guidelines.
Methods: A prospective observational study was conducted over six months at a tertiary care teaching hospital, including 293 patients undergoing elective surgical procedures in the departments of general surgery, orthopaedics, ENT, gynaecology, and obstetrics. Data on the choice of prophylactic antibiotics, timing relative to surgical incision, and duration of postoperative use were collected and compared with guidelines from the Indian council of medical research (ICMR), American society of health-system pharmacists (ASHP), and the world health organization (WHO).
Results: General surgery accounted for 51.9% of procedures, followed by orthopaedics (25%) and ENT (13.5%), with gynaecology and obstetrics together at 9.6%. Cefotaxime was the most frequently used antibiotic, particularly in obstetrics (100%) and general surgery (70.4%), whereas gynaecology predominantly used a cefotaxime-metronidazole combination (66.7%). SAP was administered within the recommended 60-minute window before incision in 80.7% of cases, with the highest adherence in obstetrics (100%). Discontinuation within 24 hours occurred in 77.8% of general surgery and 92.3% of orthopaedic cases, whereas extended use was common in obstetrics, ENT and gynaecology.
Conclusions: Although SAP timing was generally appropriate, the overuse of third-generation cephalosporin, the absence of cefazolin, and prolonged prophylaxis in some departments highlight the need for department-specific guideline adherence